Antiretroviral therapy enrollment characteristics and outcomes among HIV-infected adolescents and young adults compared with older adults--seven African countries, 2004-2013.
Although scale-up of antiretroviral therapy (ART) since 2005 has contributed to declines of about 30% in the global annual number of human immunodeficiency (HIV)-related deaths and declines in global HIV incidence, estimated annual HIV-related deaths among adolescents have increased by about 50% and estimated adolescent HIV incidence has been relatively stable. In 2012, an estimated 2,500 (40%) of all 6,300 daily new HIV infections occurred among persons aged 15-24 years. Difficulty enrolling adolescents and young adults in ART and high rates of loss to follow-up (LTFU) after ART initiation might be contributing to mortality and HIV incidence in this age group, but data are limited. To evaluate age-related ART retention challenges, data from retrospective cohort studies conducted in seven African countries among 16,421 patients, aged ≥15 years at enrollment, who initiated ART during 2004-2012 were analyzed. ART enrollment and outcome data were compared among three groups defined by age at enrollment: adolescents and young adults (aged 15-24 years), middle-aged adults (aged 25-49 years), and older adults (aged ≥50 years). Enrollees aged 15-24 years were predominantly female (81%-92%), commonly pregnant (3%-32% of females), unmarried (54%-73%), and, in four countries with employment data, unemployed (53%-86%). In comparison, older adults were more likely to be male (p<0.001), employed (p<0.001), and married, (p<0.05 in five countries). Compared with older adults, adolescents and young adults had higher LTFU rates in all seven countries, reaching statistical significance in three countries in crude and multivariable analyses. Evidence-based interventions to reduce LTFU for adolescent and young adult ART enrollees could help reduce mortality and HIV incidence in this age group.
Auld, AF; Agolory, SG; Shiraishi, RW; Wabwire-Mangen, F; Kwesigabo, G; Mulenga, M; Hachizovu, S; Asadu, E; Tuho, MZ; Ettiegne-Traore, V; Mbofana, F; Okello, V; Azih, C; Denison, JA; Tsui, S; Koole, O; Kamiru, H; Nuwagaba-Biribonwoha, H; Alfredo, C; Jobarteh, K; Odafe, S; Onotu, D; Ekra, KA; Kouakou, JS; Ehrenkranz, P; Bicego, G; Torpey, K; Mukadi, YD; van Praag, E; Menten, J; Mastro, T; Dukes Hamilton, C; Swaminathan, M; Dokubo, EK; Baughman, AL; Spira, T; Colebunders, R; Bangsberg, D; Marlink, R; Zee, A; Kaplan, J; Ellerbrock, TV
Volume / Issue
Start / End Page
Pubmed Central ID
Electronic International Standard Serial Number (EISSN)